Background: One of the most important stages in rhinoplasty is the control of nasal tip rotation.Different techniques have been proposed to achieve this goal.We aimed to compare the effects of two methods of Septocolumellar Suture (SCS) and Lateral Crural Overlay (LCO) on nasal tip rotation by measuring of Columella-Labial angle.Methods: In a single-blinded clinical trial, 148 patients were selected among the patients who were candidates for rhinoplasty in Sina Hospital in Tehran, Iran 2024.The patients were randomly divided into two groups (each group contained 74 subjects).The patients in the first group were operated on using LCO technique, and the patients in the second group were operated on using SCS technique.Columella-Labial angle of the samples were evaluated using the photographs of the samples before and six months after surgery.The obtained results were compared using SPSS software and t-paired and Mann-Whitney statistical tests. Results:The mean Columella-Labial angle in both groups was more than that before surgery (P<0.001).The mean Columella-Labial angle before surgery in the SCS group were higher than that in LCO group and this difference was significant (P<0.001).The Columella-Labial angle difference was also significant between the two groups after surgery (P = 0.005), and Columella-Labial angle in LCO group was higher than that in SCS group (P <0.001). Conclusion:LCO technique increase Columella-Labial angle more than SCS technique.Therefore, it is recommended that LCO technique to be used in patients with who need greater Columella-Labial angle change.

Background: Adjuvant-induced autoimmune syndrome (ASIA), described in 2011, includes autoimmune reactions triggered by environmental adjuvants, such as silicone breast implants (SBI).Symptoms include fatigue, sleep disturbances, appetite changes, muscle pain, fever, among others, with pathophysiology involving a combination of genetic predisposition and adjuvant exposure, leading to abnormal immune responses.We aimed to define clinical profiles and outcomes of patients with SBI, clarify ASIA's clinical implications, and guide future research.Methods: Using the PRISMA-ScR framework, a scoping review was conducted to identify clinical profiles, preexisting conditions, prosthetic anomalies, and outcomes of patients with ASIA syndrome associated with SBI.Searches were performed in Medline, Scopus, Lilacs, and Google Scholar to locate relevant studies.Results: Of 35 selected studies, 21 were case reports, 6 case series, and 8 cohort studies, identifying 848 patients, predominantly from the Netherlands (n=513), with an average age of 45-47 yr.Common medical histories included autoimmune diseases and breast cancer, while frequent implantrelated anomalies were capsular contracture and rupture.Musculoskeletal symptoms and fatigue were the most prevalent, and implant explantation was the primary treatment, resulting in symptom improvement for most patients. Conclusion:This review highlights the clinical features of ASIA syndrome in patients with SBI, particularly musculoskeletal symptoms, fatigue, and the presence of positive antinuclear antibody as a potential marker.However, the relationship between SBI and ASIA remains controversial.Despite limitations in current evidence, ongoing clinical monitoring and further research are crucial to better understanding and managing ASIA syndrome in patients with SBI.

We aimed to review the clinical approach to diagnos and surgical management of traumatic extraocular rectus muscle disruptions, a rare but significant cause of strabismus and diplopia in the adult trauma patients.This review examined the anatomy of the four rectus muscles, mechanisms of injury, clinical presentation, imaging evaluation, classification of injury types, management strategies, outcomes, and future directions in treatment.Extraocular rectus muscle disruptions occur through blunt trauma (typically causing muscle entrapment in the orbital fractures) or penetrating trauma (causing laceration or avulsion).Clinical features include diplopia, restricted eye movement, and in some cases, visible muscle prolapse.Imaging evaluation includes computed tomographyas first-line approach, with magnetic resonance imaging providing superior soft tissue detail, and anterior segment optical coherence tomography offering valuable information for surgical planning.Management focuses on early intervention, with surgical repair ideally performed within 24-48 hours for entrapped muscles and within days for lacerations or avulsions.Outcomes vary based on injury severity and timing of treatment, with better prognosis associated with early intervention.While traumatic extraocular rectus muscle disruptions present complex challenges, prompt diagnosis and surgical management often yield favorable results.Future advances in treatment might involve advanced imaging techniques, engineered tissue for muscle reconstruction, refined surgical approaches, and improved interdisciplinary trauma care protocols.

Vitiligo, a pigmentary skin disorder, poses therapeutic challenges due to its progressive nature and varied treatment responses. We aimed to investigate the efficacy of a novel approach, combining microneedling with topical 5-Fluorouracil (5-FU), compared with microneedling with Fluocinolone and microneedling alone for treating vitiligo lesions. A single-blinded clinical trial was conducted from Aug 2022 to Feb 2023 at Ahvaz University of Medical Sciences, Ahvaz, Iran. Twenty patients with persistent vitiligo lesions were randomly assigned to three treatment groups. Microneedling was performed using Dermapen cartridge 36 once a week for 12 wk. In patch A, 5% 5-FU cream was applied immediately after microneedling; in patch B, patients used fluocinolone 0.025% cream twice daily; and in patch C, microneedling was performed alone. Clinical repigmentation was evaluated using the G-score scale, and treatment side effects were recorded. Microneedling combined with 5-FU demonstrated significantly higher repigmentation rates, with 70% of lesions showing moderate to excellent responses (P<0.001). In contrast, microneedling with Fluocinolone and microneedling alone exhibited lower response frequencies. Side effects were minimal, with only one patient experiencing burning and itching in the microneedling and 5-FU group. No corticosteroid-related complications were observed. Six months follow-up revealed sustained repigmentation in the microneedling and 5-FU group, contrasting with no response or recurrence in microneedling alone-treated lesions. Microneedling combined with topical 5-FU presents a promising therapeutic strategy for vitiligo lesions, yielding superior repigmentation outcomes compared to other treatments.

Pressure injury/ulcer is localized damage to the skin and/or underlying tissues primarily caused by prolonged unrelieved pressure, particularly in patients with limited mobility. The increasing incidence of pressure injuries as a result of aging population and growing number of nursing home residents along with the posing socio-economic burden highlights the importance of increasing our understanding of this global problem, and the available preventive and therapeutic strategies. Surgical intervention using flap reconstruction is the mainstay therapy for management of pressure injuries with advanced stages. We present a comprehensive review on various types, indications, advantages and limitations of flaps used in reconstruction of advanced-stage pressure injuries.

Background:Mucormycosis is a fungal infection with diverse clinical manifestations, the most common of which, i.e., the classical form of rhino-orbital cerebral mucormycosis (ROCM), has had a significant prevalence among patients recovered from COVID-19. We aimed to investigate the findings of ROCM imaging recorded at Imam Khomeini Hospital in Ahvaz, Iran, in 2022.Methods:This retrospective study reviewed the files of patients definitively diagnosed with mucormycosis and COVID-19. Imaging procedures performed on patients included non-contrast CT scans (CT imaging protocol: from vertex to mandible without contrast for evaluating sinus contents, bone erosion, osteomyelitis, pre-sinus or orbital invasion). Key imaging findings were assessed and documented, and findings were evaluated.Results:The mean age of subjects was 53.11 ± 14 years, with the majority being male (55.3%). All subjects had nasal and sinus involvement, but their brains were unaffected. Approximately 36% of subjects had ocular involvement. In imaging findings, left pterygopalatine involvement had the highest prevalence (27.7%), while left extraocular muscle involvement had the lowest prevalence (4.3%). Patients with lamina papyracea and extraocular muscle involvement all had ocular involvement, which was statistically significant. Additionally, those with hard palate erosion had significantly higher ocular involvement rates (5 out of 6 cases with hard palate erosion).Conclusion:Rhino-orbital cerebral mucormycosis is associated with nasal and sinus involvement, and diabetes and male gender are predisposing factors to this disease. CT, as a complement to other clinical evaluations, dramatically aids in diagnosing and identifying the extent and complications of the disease.

Background: Implantology is a widely accepted treatment, as it restores aesthetics and function, and is the preferred option for replacing missing teeth. In mandibular implant surgery, the Inferior Alveolar Nerve Block (IANB) is the most common anesthetic technique, as it eliminates sensation on one side of the jaw, floor of the mouth, teeth, tongue, and gums. However, its high failure rate is due to the technical difficulty of the injection procedure. Additionally, deep anesthesia from IANB carries risks such as damage to the mandibular canal. In contrast, infiltration anesthesia desensitizes the inferior alveolar nerve locally, allowing patients to perceive pain and alert the dentist if the implant approaches the nerve. We aimed to compare the effects of IANB and local infiltration anesthesia for posterior mandibular implant surgery.Methods:This prospective, randomized, double-blind clinical trial followed a split-mouth design, involving 29 patients undergoing bilateral implant surgery in the posterior mandible within a single session. On one side, IANB anesthesia was used, and on the other, infiltration was administered. Pain was assessed using the Visual Analog Scale (VAS).Results:All 58 implants were analyzed. The VAS scores during surgery were significantly higher for the infiltration technique (P = 0.03). However, no significant difference in pain was observed 24 hours post-surgery (P = 0.223).Conclusion:Both IANB and infiltration anesthesia are effective for mandibular implant surgery, but IANB offers more reliable pain control, making it preferable for complex cases, while infiltration is suitable for less invasive procedures.

Ocular ptosis, or drooping of the upper eyelid, has diverse etiologies, including neurologic and non-neurologic causes. Aponeurotic ptosis is a common cause in the elderly and traumatic or mechanical causes can affect any age, mimicking a neurologic cause. The neurologic causes are diverse but especially arise peripherally from pathologies affecting the nerve, neuromuscular junction, and muscles. The choice of treatment depends on the particular cause, but surgical intervention can also be an option in appropriately selected neurological patients whose ptosis remains embarrassing despite the best medical treatment. Myasthenia gravis, an autoimmune disorder targeting the neuromuscular junction, is a significant cause of ocular ptosis. The treatment is mainly by symptomatic and immunosuppressive medications, but surgical interventions, such as blepharoplasty, may be considered in some cases of socially embarrassing ptosis.

The little finger permanent abduction is an annoying deformity usually along with Wartenberg's sign (a consequence of ulnar nerve palsy), but there are several ways to correct this condition in rheumatoid arthritis as well. We aimed to investigate the effect of surgical intervention on patients. The current study was a clinical trial which was done at Hazrat Fatima Hospital of Tehran, Iran from 2020-2022, where 15 patients with an age range of 21-48 years were investigated. All these patients had complications of ulna nerve damage. After the intervention (tendon transfer), the angle change of the fifth finger was compared with before the surgery. A significant improvement in reducing the angle of the fifth finger after surgery was observed in patients (P<0.05). Tendon transfer is one of the best techniques for the treatment of ulnar injuries.

Inguinal hernia is one of the most common cases of elective surgery. Several methods are used to repair inguinal hernia, however, none of these methods have been introduced as the preferred method. Based on this, the current study was designed with the aim of comparing the postoperative short-term complications and recurrence after one year between laparoscopic transabdominal pre-peritoneal (TAPP) and Lichtenstein tension free repair in the treatment of primary unilateral inguinal hernia. In this clinical trial study, 122 patients who were candidates for inguinal hernia surgery in Ahvaz Golestan Hospital, Ahvaz, Southern Iran in 2022 were randomly assigned to two laparoscopic (TAPP) and open (Lichtenstein) surgery groups. Patients were compared in terms of short-term complications (hematoma, infection, seroma), post-surgery pain and number of hospitalization days, surgery duration, scar length and one-year recurrence rate. Wound infection, seroma, and hematoma after surgery in the TAPP group were significantly less than the patients in the Lichtenstein group (P=0.002). Pain intensity, recurrence rate and mean length of surgical scar in laparoscopic group patients were lower than open method group (P=0.001). The mean duration of surgery in the laparoscopic group was higher than the Lichtenstein group, but there was no remarkable difference (P=0.396). The mean duration of surgery in the TAPP group was higher than the Lichtenstein group, but there was no notable difference (P=0.396). The TAPP method has an obvious advantage over the conventional open surgery of Lichtenstein, especially in terms of reducing the initial postoperative pain and the occurrence of complications and recurrence after surgery.